Laserfiche WebLink
APPLIC.,iION FOR CONSTRL.:TION <br /> PERMIT <br /> ISE EVO2rESD <br /> CITY OF •I I vr11 <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK-PLEASE PRINT <br /> qyN 1n,, "�I, / MAIL ADCPI'.•. <br /> all ZIP PONE <br /> /1'�9k1` Zc�7rro�E,Q /35/09 !l 'NAcmg lhwti ,,,WA ut+ lmamo GsloPia <br /> IENANT (.MIL ADDRESS OTT ZIP PHONE <br /> ARCHITEGTORDESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL EOTAMOOR MAIL ADDRESS CITY ZIP PHONf LICENSE• <br /> An;, o IN".e <br /> MFLNAMGLL LOHTRACIOR MULADDRE!! CITY ZIP PHONE LICENSE• <br /> PLUMPNOCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> CIWORK <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ DEMOLITION ❑ WOOOSTOVHFRPL INSERT ❑ BUILDING RELOCATION <br /> TENANT NIPROVEMENT OR INTER"REMODEL ONLY c FACTPERSONANDPHONENO <br /> CONTRACT PRICE Of IAORK <br /> DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br /> PwPDBEO U!E a BUIIawG I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> C7 A e'r �lL� KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> LEGAL DEscnlaTdlAa PROPETmaNGWN L oR ArTACHr conEBl ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> WHETH ER SPECIFIED HEREIN OR NOT.THE GRANTINGOFA PERMIT DOES NOT <br /> PRESUME TO ONE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> LCT__.. _ BLOCK__Of ANYOTHER STATEOR LOCAL LAWREGULATINGCONSTRUCTION OR THE PER- <br /> FORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> -- -- AND 1 COMPLY WITH THE STATE CONTRACTORS LAN 1877 RCW AND <br /> 296.200 WAG G <br /> SIGNATURE OF CORRA�CT�DDFI OR AUTNDTKZED AGENT DATE <br /> "I " ' ^� APNOEA TBUSINESSLICENSENO USINElS NAME ----- - <br /> &� _ ��L <br /> PLUMBING MECHANICAL <br /> N0, TYPE OF FIXTURE OR ITEM FEE NO, TYPE OF EQUIPMENT — _ FEE <br /> WATE1I CLOSET(TOILET) NC—AIHNDLG UNITS—H.P <br /> BATHTUB FORCED AIR SYSTEMS—BT.U. MEA <br /> _ LAVATORY(WASH BASIN) _ _ UNIT HEATERS—BTU. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN BINK S DISP. VENTILATION FAN <br /> DISHWASI IER RANGE HOOD <br /> LAUNDRYTRAY _ _ WATER HEATER <br /> _ CLOTHESWASHER _ _ WOODSTOVE <br /> _ URINAL _ METAL FIREPLACE B CHIMNEY <br /> _ DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS OAS PIPING <br /> ROOF DRAINS—FAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR ETC I <br /> ,_ M liac s PAL <br /> VAIv[, <br /> SUBTOTAL { 1 SUBTOTAL S <br /> PERMIT i D IW. PERMIT $ <br /> TOTAL FEE S 761 TOTAL FEE S <br /> FPONI BETMCK PEAR BEIBACK SIDESETSACK PGA.CNEOKNUMsea FEE RECE."NO <br /> USE ZONE LOT AREA VAGANTBGA FEES VALUATION FEE <br /> O VES O NO <br /> TYPED CONlI OOGUANCYGFEAP NO OF DWELLING UNIX BDILDING G <br /> uLDWABLVAc1Vu PLUMBING <br /> MZEOBLDG NO OF STORIES RSM( OCc LOADn If MECHANICAL <br /> ION <br /> NEAGHT UMIGTK)N OTHER _ <br /> FIRE SPA NKLERSAEWIRED one ONG STATE BUILDING SURCHARGE <br /> STATE ENERGY SURE ROE <br /> RPPUGTION ACG BT RANSAPAIBT <br /> PUBLIC WORKS <br /> TOTAL l 5 <br />